Hips are an integral joint to appropriate movement and function of the whole body. Hips have traditionally been viewed as a joint that wears out and gets replaced when you’re old but fortunately our understanding has come along in leaps and bounds and there are many options to manage hip and groin pain.
The hip is a ball and socket joint consisting of the ball from the pelvic bones (called the acetabulum) and the socket being the thigh bone. It tends to fit in their quite well as stability is paramount to a functioning hip and body. The hip also consists of
- The hip flexors cross the front of the hip and lift the thigh.
- The adductors or groin muscles are on the inside of the thigh and act to stabilise the pelvis from the inside
- The abductors are on the outside of the thigh (the glute medius and minimus) and stabilise the pelvis while walking and running
- The extensors are at the back of the hip and include the ever important gluteal maximus. Their job is to push the body forward in weight bearing positions
- The hip has a rotator cuff which rotates the hip inwards and outwards but primarily acts to keep the ball from the thigh bone in the middle of the socket
- The hip has a labrum which is a lip that helps to hold the ball in the socket
Everyone hips is very different and control of the hip is crucial. Some common issues we deal with include
- Femoroacetabular impingement (FAI)
- This is when the bones of the thigh or the pelvis grow bigger in certain points which cause them to bump into each other during certain movements
- Hip chondropathy/labral degeneration
- This is damage to the cartilage surface of the thigh bone or pelvis or to the lip attached to the pelvis.
- Hip dysplasia
- This refers to a hip joint which allows too much movement and thus can cause instability or the ball to roll around too much in the socket
- Adductor tendinopathy
- This refers to extra load on the adductor tendons which attach to the pelvic bones. Common in soccer and rugby league players
- Sportsman groin/Osteitis pubis/Pubic symphysitis
- Refer to a general group of pathologies relating to failure of the tendons, bony attachments and bones to stabilise the pelvis and groin. This includes muscles of the anterior hip, abdominals and adductors. Any or all can contribute to the problem
- Gluteal tendinopathy
- Refers to tendon overload or pathology on the gluteus medius tendon. Common in ladies and runners and involves the compression of the gluteus medius tendon on the hip bursa (sacks of fluid) or thigh bone
- Iliopsoas Tendinopathy
- Refers to pain in the hip flexor tendon across the front of the hip/abdominals. Often related to sports where people kick the hip flexor tendon can get compressed on the bones in the front of the pelvis.
Treatment for all hip problems involves identifying issues with the pathology as identified above but also and then making sure we deal with the cause or effect appropriately. There are no one size fits all approach to hip rehab. We need to identify the contributors to your hip and groin problem and manage them. This includes
- Improving mobility of the lumbopelvic area and hip joint
- Strengthening the weak and injured areas and ensure appropriate muscle balance
- Ensuring better control of the pelvis through gluteal strengthening exercises
- Lumbopelvic and trunk strengthening including abdominals
- Educating people on how to use their hip for things like standing, sitting to standing and squatting
- Strength and power exercises to meet the demands you wish to place on your body